ER s14e13 Episode Script

Atonement

Ah. Imagine waking up here every morning. Bettina, I can't afford this. Yes, you can. I did the math. - You did the math? - Mm-hm. Time to move out of your med school apartment and invest in something. My apartment is fine. So, what do you think? - Oh, it's beautiful. Told you. The sellers did a great job on the renovation. The kitchen, the moldings, these yummy floors. Bamboo flown in from Brazil. And there's a gym and a children's game room in the basement. You two got kids? - No. - No. Listen, don't rush it. When you're newlyweds and it's just the two of you against the world well, you can't beat that. Okay. It'll be gone by the end of the week, so if you're at all "interested " make an offer. No, thanks. - It's, uh, the first place he's seen. - Think about it. - I'll call you tomorrow. - No, don't, please. I'm just looking. Hey, Sam. - It wasn't just the battery. - Where'd you get my keys? - You also had alternator issues. - You stole my keys and fixed my car? I think the proper response would be, "Thank you, Tony. " Also, I tightened the connections and got you all charged up. Ooh. That sounds like fun. - Thought you were dating the chaplain. - He's talking about my car. Car. She made a reasonable assumption about our relationship and you had a seizure. I wasn't feeling the realtor. I wanted to get out. We're adults. The topic of commitment shouldn't be off-limits. - It's not off-limits. - Really? You haven't looked me in the eye since we left. - Come on, it's not like that. Pratt. Hey, Pratt. There's a kid and an old guy who've been pulled out of the lake. - Take one with Grady. - You got it. Let's talk about this later, okay? You're admitting there's something to talk about. - Hey, Chaz, how you doing? - Fine, thanks. What up? Robert Truman, 68. Jumped in after a kid who fell into the lake. Thought I could get in and out. Too cold. Heart rate's 68, pulse ox good. Temp was 90. - My lungs froze up, couldn't swim. - Does anything hurt, sir? - I'm fine. Take care of the boy. Barely moving air. Too cold, can't get a sat. - Twenty-four gauge Plv, that's it? - He needs central access. - Mom is here. It's okay. This is your fault. You made this happen. He needed my help. I thought if I could only do Why won't you leave us alone? - No, I'm sorry, I tried to - Stay away from my son. He's hypoventilating. We need to bag him. - Doctor, please take care of that child. - We're gonna concentrate on you now. If you wanna help me, you need to help that boy. - Mr. Truman - Please save him. Save him or I'm going to hell. The nurse wants to bump our meniscus repair until tomorrow. Tell her to kiss your ass, or maybe mine. She's cute. - What's up, Ortho girl? - Morris, what are you doing here? - I'm a surgeon for the day. - What? Yep, it's the ER's new trauma-exchange program. - I never heard anything about this. - ER staff can spend a day following trauma patients to the O.R. - You gonna scrub in on cases? - Hope so. Be good and Harold might let you hold his retractor. - Definitely. Ha-ha. Dude, I gotta go. There's like a hundred doctors here. - After you. - No, after you. Rasgotra, you're up. Silas is our snowmobile versus brick wall. Post op day one She's so cute, isn't she? - Day one from laparotomy - With her little accent. Hemoglobin's stable, slept well. Got a chest x-ray. No infiltrates. Mild atelectasis bilaterally. - Okay. - That means areas of collapsed alveoli. We know what atelectasis is. It's probably nothing, but I can repeat the film this afternoon. Okay. Hey, what's the definition of a double-blind study? - Two ortho docs looking at a chest film. - Zing. Don't pretend that's not funny. You taught me that joke. Oh, my God, I love this girl. He was collecting samples from the lake for a science project. - Something about algae in winter. - Core temp's 74.3. More suction, please. Then that man just appears out of nowhere again. Tube. He's been to the store, trying to talk to me while I work. I thought he was just some lonely old guy. And yesterday, I saw him outside of my house. Then when he saw me looking, he just walked away. And then today at the lake I went there to tell him to stay away. I told him I was gonna call the police. Gabriel must have slipped in while my back was turned. I have no idea how long he was there before I realized. That man jumped in after him? He said, "Call 911," and then he just jumped. Sam, call Respiratory for a vent and set up for bilateral chest tubes. Have Central bring in a circulating-water blanket. - He'll do better with a Bair Hugger. - Both work. - Bair Hugger's better. - Show me the data. You kids work it out. You guys all right in here? Yeah, his core temp's up to 94, but his EKG shows ischemic changes. Could have been caused by the strain of the cold swim. - Hey. - These flattened T waves. I've had those for years. It's definitely not an MI. I'm a doctor. Retired six years, but I can still read an EKG. Okay, well, let us check your troponins just in case. - Yeah, just knock yourself out. - Where'd you practice? Stateville, 12 years. - Stateville Penitentiary? - Yes. Bet that was intense. You guys seem fine. - I'm going back in with the kid. - How is he? - I can't talk about his treatment. - Of course. Hey. Fun rounding with you this morning. - Hi, Archie. - Want some advice? - No. - You need to work on your style. - Excuse me? - Yeah, you're too serious. Have fun, take some joy in your work. - I'm fun. - You're English. I get it. It's hard to let your hair down. You are in America now. You know, I don't know what you're basing this on since You know how hard it was to find a jersey that small? - Hockey? - See? I'm fun. We're gonna finish then head to the rink. Oh, Neela, this is so hot. - Can you do a triple axel? - Dude, that's figure skating. - Oh. You friends with that guy? Sort of. - Oh, tell the truth. We slept together. She gave me a rash. - Hey, I'm sorry about the last few days. - Oh, hey. I've been working 11 a. m. To 11 p. m., which is like falling off the planet. It's okay. I've been slammed too. I'm leading a seminar at the CAHC tomorrow and I'm way behind. What's CAHC? Complementary Alternative Health Conference. - I told you all about it. - You didn't. You may have been in a post-coital stupor. But I am presenting data on the effects of prayer on healing. - They actually have data on that? - Yes. Ahem. Several studies have shown that patients who have people praying for them get well faster than those who don't. - Ooh. Spooky. - Shut up, the results are cool. When you get a minute, I got a guy for you in Trauma. No, no, not another consult. I have to get this talk together or I'm screwed. He saved a kid from drowning in a lake. The kid's not doing so well and he's freaked out. Come on, now. Okay. I have a baby-naming ceremony in the NICU and then I am meeting with a statistician to go over the slides for the talk. - I'll come back after that. Thank you. - Chest x-ray on Robert Truman. - Good. - You're kidding me. - Ugly, right? - Yeesh. Who's that? - Old lake guy. Order a chest CT and I'll get an official read on that. Tell me you don't need a radiologist to see this film is abnormal. - Diffuse lung nodules, I know. - Lung mets. I called you to get your take on the differential before I go in there and tell the man he has metastatic cancer. Couldn't it be miliary TB or cocci or sarcoid or something? Yeah, but in a 68-year-old guy, odds are it's gonna be mets. - Great. - So anything else? Guess not. Thanks for the consult. Dr. Truman. Robert, please. In your days as a prison doc, did you ever get tested positive for TB? No, I had the PPD every four months. Any coughing, fevers, night sweats? Huh. The chest x-ray. Metastatic prostate cancer. It spread to my lungs and my bones before I even knew I had it. - I'm sorry. - Well, I guess it's my retribution. Excuse me? When men try to do God's work, bad things happen. I wish I'd realized this before I killed that boy's father. Another run of v-tach. Two hundred of bretylium and start an infusion. - Core temp's down to 71. - He's getting colder? Cold blood in his extremities rushes up to his heart and drops the core temp. Your Bair Hugger worked a little too well. His heart can't beat normally at this temperature. Sam, call the ECMO tech. Don't you think that's jumping the gun? What about peritoneal lavage? - What's ECMO? - Cardiac bypass. It's the only thing that's gonna warm the core. It's too dangerous. His temperature is 71. He's having runs of v-tach. - We're there. - Bleeding, infection He knows the risks. - Thank you. But I'm with Sam. Gabriel's got a pulse and a decent BP. Exhaust all options before jumping to ECMO. I'll get the stuff. Put a tube in belly and flush warm fluids to see if we can raise his core temp. - Hey, Sam, what's with you today? - Nothing. - Then why do you have to plan B me? - Plan B you? Whatever I say, you have a better idea. - That's not true. - Yeah, Sam, it is true. Bair Hugger versus water blanket. Morphine versus fentanyl. Okay, come on, you sound crazy. Whatever I want, you give me that look. - What look? - That look, that one, right there. I don't accept orders from "someone " because they come from a doctor or a man. I've been doing this a lot longer than you have. If you don't like that, it's too bad. Back at Stateville, my job was to give lethal injections to death-row inmates. - Wow, that's heavy. - Yes. People could watch through a window. And I remember I remember her. Trying to be brave for the baby as I injected the thiopental the Pavulon potassium. Gabriel was only 2. He never knew his dad. Dr. Truman, you don't really have to talk about this. No. Back then, I thought it was the right thing. I thought there were criminals who deserved to die and lethal injection was the most humane way. As time went on, my thinking's changed. About the death penalty? Who lives and dies should be decided by God, not a jury. I've spent the last five "years " tracking the loved ones of the men I've killed. Trying to make amends with those families. And how do you make amends? Financial aid, mostly. It's all I have to offer. I paid a mortgage, bought a car, sent a child to college. Some people told me to get lost. Others took what I could offer. Well, that's really brave. - And generous. - No. They're all acts of contrition. Small things. Nothing will ever bring back a husband or a son, father. Saving a kid's life isn't a small thing. I'm just trying to tell God how sorry I am for what I've done. Please. I need that boy to live. Tell that freak to stop staring at me. Not many people would jump in a frozen lake for a stranger. - He's not a stranger, he's a stalker. - V-tach, lost the pulse. Starting compressions. - Oh, my God. What's happening? His heart has stopped beating effectively. We can't shock it back until he's warmer. This looks like the right room. Who called for ECMO? The conservative route wouldn't work so I gave Teddy the heads-up. Put him on. This is a cardiopulmonary bypass machine. It will function as Gabriel's heart and lungs. - Sam, you should've listened to me. - Well, let's hope it works. Celia, do you have any family we need to call? Or Gabriel's dad? - His dad's been dead a couple years. - How about your family? Father's out of the picture. Haven't talked to my mother. - Anspaugh's on his way to cannulate. Do it here. - Surgery has to. It's protocol. - Chief is coming for a central line? They're a little short-staffed today. All up at a big conference or something. Yeah, let's do this, let's go. - Rasgotra, isn't this fun? Uh, especially the part where I get to see my Attending in his jock strap. Okay, go. I'm streaking to the blue line in the dump and chase. - What do you do? - Head to the far corner, dump in the net. - That is exactly right. - Okay, everybody, listen up. Smart, aggressive, no mercy. Smart, aggressive, no mercy. Smart, aggressive, no mercy. Smart Machine is doing the work for his heart and lungs. We're gonna take out the breathing tube. I see. When his temp's up, his own heart will kick back in. Well, that's the hope. What do you mean, that's the hope? Well, I'm sure Dr. Gates has explained that Gabriel's "tissues " may be permanently damaged because of the cold. I explained that, but we're trying to think positive here. Right. Look, we all hope this brings him back, but he's been down for a long time. Did over an hour of CPR. Celia, call someone. A friend, family, it doesn't matter. You just need some support. You don't know what I need. I'm a single mom. I know asking for help feels like cheating sometimes. Jimmy, Gabriel's "dad " he was one of those guys who couldn't stay out of trouble. Running drugs, stealing cars. I was an idiot. I thought he'd change. That's human. And I told my mom Jimmy and I were gonna raise the baby together and she kicked me out of the house. She said, "You may be "lost " but I am not gonna have a guy like that around the rest of my kids. " Looking back, she was probably right. Celia, there's a very good chance that Gabriel's heart won't start up again. No, please, please don't say that. This is gonna work. Guys, I need another liter of NS and an ABG kit. Okay. Yeah, I got it. And check an ionized calcium while you're at it. The last one was low. That's my mom. Could you call her? Right away. Yeah! Game on. - Who are we playing? - Pedes, I think. I saw the pathologists practicing in the parking lot. And now, the starting lineup of County General's very own. Unstoppable, irrepressible, the Mighty Docs. Playing right wing, Lucien Dubenko. They are such drama queens. We're playing the trauma surgeons? Beat them in the last five seconds of the finals last year. Left wing, Dusty Crenshaw. Oh, my God. On defense, Harold Zelinsky. Playing center: - Archie Morris. - Oh, no way. - Way. - Oh, this explains everything. Weird behavior, the program Ruse to play on this team and kick your ass. - He's a ringer. - Yeah, baby, huh? I had a 26-year-old kid on the table, convicted of killing a cop. I could see his family, pleading, praying. I injected the drugs and he didn't die. He lay there, awake, quivering. Lethal doses of three different agents and he was still alive. Parents were crying, claiming a miracle. - What happened? - The IV infiltrated. The drugs pooled in his soft tissues instead of going into his bloodstream. So I placed another IV, drew up another round of meds and pushed. And this time it took him 90 seconds to die. Seven months later, a police officer came forward. The boy was framed for the murder. Hm? He didn't do it. You couldn't have known that. God tried to stop me from killing an innocent man and I ignored the sign. How can I even hope for forgiveness? I think sometimes it's easier to feel guilty than forgiven. Which means what? That maybe your guilt over these deaths has become your reason for living. Maybe you need a new reason to go on. I don't want to go on. Can't you see I'm old? I have cancer. I've had enough. The only thing that is holding me back is that I am afraid. - I'm afraid of what comes next. - And what do you think that is? Oh, you tell me. Is atonement even possible? What does God want from me? I think it's up to each one of us to interpret what God wants. So people can do anything? They can rape, murder, steal, all in the name of God and it's okay? - No, that's not what I'm saying. - What are you saying? Because all I'm hearing is some new-age, God-is-love, one-size-fits-all crap. - Hey, Dr. Truman - No, I don't have time for this now. Greg, it's okay. - Look, I understand - No, you don't understand. You don't understand. How could you possibly say that? Now, you listen to me. I want a real chaplain who believes in a real God and a real hell. You're frustrated, but you need to ask yourself No, I don't need to ask myself. I need answers. And all your questions and your uncertainty are only making things worse. - I know you're upset. - God. I need someone who will look me in the eye and tell me how to find forgiveness because I am running out of time. - I'm trying to help. - Well, don't. Just get out. Get out! Get out! Hey, Julia. Julia, come on. Listen, come on. Come on, the guy's just freaking out. He didn't mean what he said. Yeah, he did. He absolutely did. Okay, don't choke, Neela. Don't cough it up. It would be real embarrassing if you lost that puck to me. Neela. Yes. Stay down. Yes! Get up! Oh, let's see. Your eye, crap. Concentration, crap. Coordination, crap. How do we let this girl operate? Hit me. Come on, hit me. - You know you wanna. - I don't. - Come on, hit me. - Lucien. Everybody wants to take a shot at their mentor, don't they? Ha! Come on, Neela. Untie the piano, you'll skate faster, huh? Ah! Oh, no. Go, go, go. I got it. I got it. I got it. Neela, you're dead. Whoo! Hey, Gates, hold on. Have you seen Julia around? - No, not since this morning. - She's not answering her pager. She usually turns it off when she's with patients. This guy in 1, it's a mess. Do you have any questions for us, Mrs. Davies? No, Celia explained it all. She always had a head for science. Gabriel does too. He wants to be a marine biologist. ACT is 224. - Let's keep the heparin where it's at. - You sure you wanna do that? Never mind. What are you doing here? I wanted to let you know - You can't be here. - Please, I want to say Get out. Please, just go. - Maybe you should just go back to bed. - Hold on, Sam, hold on. Look, ma'am, he tried to save your son's life. Just give him a chance to say what he came to say. And afterwards you'll give this family their privacy, right? Yes. Sorry. I'm sorry for all the trouble I've caused. I'm praying for your boy. Sir, thank you for your bravery. I'm very grateful. So is my daughter. Right, Celia? Celia, tell him. Tell this man thank you. Thank you. Like you mean it. I am not 3 years old anymore. I have to call work. That's That's all. Come on, let me get you back on the monitor. - Lucien, five hole or top shelf? - I don't care, just make it count. We need a goalie here. Hey, you guys ever seen Neela drunk? You should have seen her at the ER Christmas party. She gave Anspaugh a lap dance. Woo-hoo. Could have blocked that with a wad of toilet paper, Morris. I hear she still sleeps with a blankie. She calls it her nubbie. What the hell are you talking about? Whoa! - Nice. That's right. Your career as a goalie doesn't pan "out " you can go back to work at the Jumbo Mart. You guys know she used to work at the Jumbo Mart, right? Hey, Skye. Have you seen Julia around? - No. - She had trouble with one of my patients and went AWOL. - What happened? - Are you ready for this one? My guy in 1 gave a lethal injection to the father of your boy in 2. - What? - He was a prison doctor. He used to push the drugs into the guys on death row. I guess he's had a change of heart. Excuse me. Hey, Chaz, hey. Hey, man. Hey, Celia. - Everything all right? - Yeah. Yeah, it's just work, you know? I guess she wants a commitment, but I don't know. Maybe I'm not that kind of guy. So why don't you just tell her that? Bettina's great. It's not like I'm looking for something better. You been together for a while now. - Yeah, nine months. - Hm! That must be a record for you. I like her, all right? So that's not the issue. Well, why don't you just give it a try and see what happens? It's easy for you to say. You're 20 years old and still playing the field. Greg, I've been with the same guy for almost a year now. Really? Why didn't you tell me that before? - You never asked. - All right, well, I should take these. - Cool, thanks for the coffee. - Oh, anytime. Hey, what's his name? - Andrew. - Well, I'd like to meet him sometime. We can all go to a drag club or something. Ha! Just kidding, man. That'd be cool. What you got? Mass cas at the ice rink. Ortho versus Trauma. What? You. You were a complete goon out there. - I hit you because you elbowed me. - Headhunter. - Octopus - Slasher. Can't we all just get along? Rasgotra, this isn't over. I saved your ass so many times out there. Well, maybe I wouldn't have to if you weren't such a goon. You should practice a little more. You've had plenty of practice swinging stick. Could you lay down? I don't recognize you standing up. Hey, get off of him, you wanker. The ECMO tech needs you in T-2 right away. That kid's awake. Cripes! What's going on? We see this after a few hours on the machine. They just wake up. Sat's okay on room air. Mommy? What happened? Oh, baby. Hi, baby, hi. You're okay. - Attaboy, Gabriel. Oh, thank God. - He's okay. He's gonna be okay. - I know, baby. Core temp's up to 94. This family will never forget what you did here today. Just doing our job. Well, I don't care what you say. It's a miracle. What do you say we take this kid off the machine? Sounds good. Size 8 gloves okay? Looks like good news in there. This doesn't absolve you. Don't think it does. I don't forgive you. I will never forgive you. You have to live with what you've done. Julia. Well, the lake kid is doing great. But our guy He needs you in there. I can't. All right, well, I need you in there. He's asking me all kind of questions that I don't know how to answer. You know, doubt " it's" uncomfortable. But certainty " I" don't think it's real. I mean, I went to seminary. I studied Buddhism, I spent time at an ashram. Who really knows anything with absolute certainty? Not me, that's for sure. That's why I thought an inclusive approach to spirituality would work well in a place like this. It does. It does. The patients, they appreciate what you do. No, people in crisis want rules. They want structure. Something to lean on, I get that. But it's not me. You know, we all wonder what we're doing here sometimes. That guy needs help. So come on. Come back in there with me. Let's go talk to him. I don't think so. All right. Ramsey, did you trip over the blue line? Yeah, fell on me. - Morris, hurt yourself doing a triple axel? - So who won? It was a mutual forfeit. - Didn't know you had it in you, Mayday. - Me neither. - X-ray's negative, home with splint. - All right, who's next? Hey, Neela, how's your boo-boo? It's my dominant hand. - Lf I can't operate, you're dead. - Wuss. You hack. Beyotch. - Who are you yelling at, Harold? - I don't really know. - No tenderness, bearing weight. - Hey, how's my team? They need ibuprofen, a hot tub and a glass of wine. - I like the way you think. - Okay, listen up, everyone, fun's over. Orthopods are rounding on the hall in 10. - Trauma to the ICU. - What about me? There's an ingrown toenail in Exam 3 with your name on it. Sam. What's up, buddy, you sick of us down here? No, I like it. - You like it? You're a weird kid. - He likes the Jell-O. Thanks again, doctor. You're welcome. You take care of your mom, okay? Sam, any beds open up? Well, I had to threaten the charge nurse with physical violence. But something opened up. All right, we're going to Ike Ryan's. You should come. - Should I? - Yeah. As long as if I order you a beer, you don't change it to vodka gimlet. I don't know. I have to report upstairs. I gotta do stuff here. How often do we get an outcome like this? A pulseless ice cube turned into a Jell-O loving 11-year-old in the same shift. - That doesn't happen every day. - That's for sure. - Well? - Well, I'll see if I can make it. I have sinned against heaven. And in your sight are no more worthy. Gracious God. My mortal sentence I accept. Stop. - What the hell are you doing? - I am in hell. Do you understand? I am in hell already. I might as well go. Listen to me. You saved a little boy's life. No, it is not enough. I can't change my destiny. There isn't time. Did it ever occur to you that your destiny was for you to be on that pier this morning? That maybe your life's path and all the choices that you made led you right there. - Why? - So you could save that kid. Why? Why would God do that? Why would he have me kill 17 people to save one? You may not understand it but that little boy is alive because you were there. Now, whatever you need that to count for, it counts. It doesn't make sense. It doesn't have to make sense. That's why it's called faith. All right. - Hey, guys. - Hey, Sam, great job today. - Thank you, you too. - Hey, Gabriel all tucked in? Yes. The ICU nurses are fawning all over him. - My turn to win some money. - All right. - So, what are you drinking? - Actually, I can't stay. So you came here to tell me that you can't come here? - Yeah. - Really? Have you heard of the cell phone? You know what, you're right. It's dumb. I shouldn't have come. I wasn't thinking. Wow, she admits that she wasn't thinking. Alert the media. - Screw you, Gates. - Come on, stay here. - Will you get her a beer, please? You got it. - Vodka gimlet with a twist. Okay. Definitely the most insane shift I've worked since I started here. You said that exact same thing yesterday. I did not. So are you going to Ike's after this? No, I'm not much of a group person. I need my alone time at the end of the day. Is that why you're not married? No. Then why isn't a hot, smart woman such as yourself shacked up by now? And I'm not hitting on you. Just wondering if some people aren't cut out for commitment. Nobody's cut out for commitment. It fights our DNA. - You don't believe in monogamy? - No, I believe in monogamy. I just don't believe in the concept of forever. People force the issue and then act surprised when it doesn't work out. You know, some people might say that your theory is a cover for a fear of commitment. Well, it takes a lot of courage to reject the widely embraced social construct of marriage. Most people assume you've got some kind of problem. Well, seems like you've got it all figured out. Some days. - Night, Skye. - Night. How'd you hurt your shoulder? Checked by Grossman after the face-off. But I hurt him worse later. Ever seen bonobos at the zoo? What's a bonobo? Pygmy chimp. Famous in the primate world for their social-sexual behavior. How fascinating. In bonobo communities sex is a way to say hello. - Oh, really? - Mm-hm. Hello. - This is so awesome. I didn't know these were here. Hot tubs are for therapy during the day, but night? They belong to the hockey team. Lucien, Skye, how's the water? Hot, very hot. Guys, this job rocks. I'm not sure what the point of that would be other than to make him feel guilty on top of everything else. Uh, I gotta go. Okay, bye. - Hey. - Hey. What's up? We need to talk. I'm sorry about this morning, okay? You had the right to be mad. Apology accepted. Look This is all new to me, okay? I haven't been down this path before. But I really, really want this to work. Do you know if you stare at an x-ray for more than 38 seconds you start to see things that aren't there? Because that's what's this is, Greg. We've stared at this thing too "long " and tricked ourselves into seeing something that isn't there. You're not listening, okay? I wanna do this. This morning, you seemed totally unsure. Who's sure about anything? This shouldn't have to be this hard. Eventually you know we would end up right back in the same place. And frankly, I don't have the time. - Thank you for waiting with me. - No problem. Oh. ECMO was a good call with that kid. We probably should have done it sooner. It's annoying but you were right. Thank you. And, Sam, I do like working with you. Other than the relentless interrogation and second-guessing and you constantly blowing me off - Shut up. when I give you orders. I hate you. I hate you too.